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General NPI Number Information
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NPI Number | 1518023464
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Entity Type | Individual
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Provider Name | TRUDY MARIE BONVINO DDS MS
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 14065 COMMERCE AVE NE
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City | PRIOR LAKE
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State | MN
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Zip | 55372-1436
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Country | US
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Telephone | 952-469-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 14065 COMMERCE AVE NE
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City | PRIOR LAKE
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State | MN
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Zip | 55372-1436
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Country | US
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Telephone | 952-469-3333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10859
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License Number State | MN
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